付彬, 郭宗琳, 高祥, 任婷婷, 杨梅, 彭桥丽. 单中心维持性血液透析患者甲状旁腺激素及钙磷达标率6年的变迁[J]. 临床肾脏病杂志, 2019, 19(6): 434-437. DOI: 10.3969/j.issn.1671-2390.2019.06.011
    引用本文: 付彬, 郭宗琳, 高祥, 任婷婷, 杨梅, 彭桥丽. 单中心维持性血液透析患者甲状旁腺激素及钙磷达标率6年的变迁[J]. 临床肾脏病杂志, 2019, 19(6): 434-437. DOI: 10.3969/j.issn.1671-2390.2019.06.011
    FU Bin, GUO Zong-lin, GAO Xiang, REN Ting-ting, YANG Mei, PENG Qiao-li. A monocenter study on 6-year changes in parathyroid hormone, blood calcium and phosphorus qualification rates in maintenance hemodialysis patients[J]. Journal of Clinical Nephrology, 2019, 19(6): 434-437. DOI: 10.3969/j.issn.1671-2390.2019.06.011
    Citation: FU Bin, GUO Zong-lin, GAO Xiang, REN Ting-ting, YANG Mei, PENG Qiao-li. A monocenter study on 6-year changes in parathyroid hormone, blood calcium and phosphorus qualification rates in maintenance hemodialysis patients[J]. Journal of Clinical Nephrology, 2019, 19(6): 434-437. DOI: 10.3969/j.issn.1671-2390.2019.06.011

    单中心维持性血液透析患者甲状旁腺激素及钙磷达标率6年的变迁

    A monocenter study on 6-year changes in parathyroid hormone, blood calcium and phosphorus qualification rates in maintenance hemodialysis patients

    • 摘要: 目的 了解单中心维持性血液透析(MHD)患者甲状旁腺激素(PTH)和钙磷达标率6年的变迁状况。方法 选取2012~2017年成都市第十一人民医院肾内科MHD 6个月以上患者分别244、313、325、434、418和331例,2012年药物治疗继发性甲状旁腺功能亢进(SHPT),2013年及以后在部分药物治疗无效的SHPT患者,开展甲状旁腺切除术。收集年龄、性别、原发病、透析病程,测血PTH(iPTH)、钙、磷、白蛋白等指标,P<0.05为差异有统计学意义。结果 (1)透析病程由(3.9±3.3)年延长到(6.1±4.0)年(P=0.000),男性占比上升(χ2=4.542,P=0.033),但年龄(P=0.653)和原发病(均χ2=0.000,P=1.000)无差异。(2)PTH达标率分别为50.82%、54.95%、54.77%、56.22%、54.07%和56.19%;血钙达标率分别为39.75%、38.02%、37.85%、44.24%、41.63%和43.50%;血磷达标率分别为39.34%、39.62%、45.85%、40.32%、34.69%和31.72%;6年间,PTH、血钙、血磷达标率均无差异(χ2=1.632、0.811、3.589;P=0.201、0.368、0.058)。(3)SHPT的患病率呈"U"曲线,分别为27.87%、21.41%、22.15%、24.65%、28.71%和29.00%,2017和2012年患病率偏高,无差异(χ2=0.089,P=0.766),2013和2014年患病率偏低。甲状旁腺功能低下患病率分别为21.31%、23.64%、23.08%、19.12%、17.22%和14.80%%,2017年明显低于2012年(χ2=4.108,P=0.043)。(4)高血钙患病率分别为24.58%、33.55%、24.62%、31.34%、26.79%和13.29%,2017年明显低于2012年(χ2=12.099,P=0.021);低血钙患病率分别为35.66%、28.43%、37.54%、24.42%、31.58%和43.20%,6年低血钙患病率无差异(χ2=3.333,P=0.068)。(5)高血磷患病率分别为51.23%、51.23%、52.72%、44.31%、51.38%和57.66%,2017年明显高于2012年(χ2=7.361,P=0.007);低血磷患病率分别为9.43%、7.67%、9.85%、8.29%、7.66%和5.74%,6年无差异(χ2=2.819,P=0.093)。(6)甲状旁腺切除术患者,PTH、血钙、血磷达标率分别是17.02%、36.17%和44.68%,甲状旁腺功能低下、低血钙、低血磷发生率分别是46.81%、53.19%和10.64%,SHPT、高血钙、高血磷患病率分别是36.17%、10.64%和44.68%。结论 (1)6年间PTH、血钙和血磷的达标率趋于平稳。(2)甲状旁腺低下及高血钙患病率在下降,高血磷患病率在增加。(3)甲状旁腺切除术可改善部分药物治疗无效的SHPT患者PTH的达标率,减少高钙血症的发生,同时也增加了低PTH的风险。

       

      Abstract: Objective To know about the 6-year changes in parathyroid hormone(PTH), and blood calcium and phosphorus qualification rates in maintenance hemodialysis patients(MHD) in a single center. Methods Respectively, 244, 313, 325, 434, 418 and 331 patients with MHD lasting for more than 6 months were selected in Department of Nephropathy of the Eleventh People's Hospital of Chengdu from 2012 to 2017. Among all the patients, some ones received medication for treatment of SHPT in 2012, and the ones who had no response to medication after 2013 underwent parathyroidectomy. The data on their age, sex, primary diseases and dialysis course were collected, and their indices including blood iPTH, calcium, phosphorus and albumin were determined. P<0.05 was considered to be statistically significant. Results (1).The course of hemodialysis was prolonged from 3.9±3.3 years to 6.1±4.0 years (P=0.000), and the proportion of males increased (x2=4.542,P=0.033), but there was no difference in age(P=0.653) and primary disease (both x2=0.000, P=1.000). (2). PTH qualification rates were 50.82%, 54.95%,54.77%,56.22%,54.07% and 56.19%, respectively. And blood calcium qualification rates were 39.75%,38.02%,37.85%,44.24%,41.63% and 43.50% respectively. And blood phosphorus qualification rates were 39.34%, 39.62%, 45.85%, 40.32%, 34.69% and 31.72% respectively. There was no difference in qualification rates of PTH (x2=1.632, P=0.201), blood calcium (x2=0.811, P=0.368) and blood phosphorus (x2=3.589, P=0.058) through 6 years. (3). The curve of prevalence rates of SHPT through the 6 years was U-shaped. The prevalence rates were 27.87%, 21.41%, 22.15%, 24.65%, 28.71% and 29.00% respectively, with higher rates in 2017 and 2012. but no difference (x2=0.089, P=0.766), and with lower rated in 2013 and 2014. The prevalence rates of hypoparathyroidism were 21.31%, 23.64%, 23.08%, 19.12%, 17.22% and 14.80%%,respectively, with the rate in 2017 notably lower than that in 2012(x2=4.108,P=0.043). (4). The prevalence rates of hypercalcemia were 24.58%, 33.55%, 24.62%, 31.34%,26.79% and 13.29% respectively, with the rate in 2017 notably lower than that inn 2012 (x2=12.099, P=0.021). The prevalence rates of hypocalcemia were 35.66%, 28.43%, 37.54%, 24.42%, 31.58% and 43.20% respectively, with no differences (x2=3.333, P=0.068) through the 6 years. (5). The prevalence rates of hyperphosphatemia were 51.23%, 51.23%, 52.72%, 44.31%, 51.38% and 57.66%, respectively, with the rate in 2017 notably higher than that in 2012 (x2=7.361, P=0.007). The prevalence rates of hypophosphatemia were 9.43%, 7.67%, 9.85%, 8.29%, 7.66% and 5.74% respectively, with no differences (x2=2.819, P=0.093) through the 6 years. (6). In the patients with parathyroidectomy, qualification rates of PTH, blood calcium and phosphorus were 17.02%, 36.17% and 44.68%, respectively; the prevalence rates of hypoparathyroidism, hypocalcemia and hypophosphatemia were 46.81%, 53.19% and 10.64% respectively. The prevalence rate of SHPT, hypercalcemia and hyperphosphatemia were 36.17%, 10.64% and 44.68% respectively. Conclusions (1). The qualification rates of PTH, blood calcium and phosphorus tend to be stable during the 6 years. (2). The prevalence rates of hypoparathyroidism and hypercalcemia both decline, but hyperphosphatemia increases. (3).Parathyroidectomy can improve the qualification rate of PTH in the patients with SHPT who have no response to medication, reduce the incidence of hypercalcemia, and increase the risk of low PTH at the same time.

       

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